JOWMA Medical Rotation at Schneider Children's Medical Center

Are you a JOWMA member?*

YesNo

Name*

First NameLast Name

What is your date of birth?

Date

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

Name of medical school*

What year of medical school are you in?*

Are you currently in good standing at your medical school?*

YesNo

Have you ever had disciplinary action taken against you in medical school?*

YesNo

If yes, please explain.

Do you agree to have your transcripts reviewed?*

YesNo

Can you speak conversational Hebrew? (Not a requirement)*

YesNo

Two week rotation request dates

Reference #1

PrefixFirst NameLast Name

Reference #1 Email Address

example@example.com

Reference #2

PrefixFirst NameLast Name

Reference #2 Email Address

example@example.com

Please share a few sentences about why you are applying for this rotation.

I agree to the following terms:

1. Application Fee a. The Participant is required to pay a non-refundable application fee of $25 at the time of application submission. b. Should the Participant be accepted into the program, this application fee will be applied toward the outstanding balance of the program cost.

2. Program Costs a. The cost for the elective rotation experience abroad for JOWMA Members is $1500. The cost for the elective rotation experience abroad for non JOWMA Members is $2000. Become a member here. b. This fee does not include additional expenses such as airfare, room and board, or any other costs associated with the Participant's involvement in the program.

3. Non-Refundable Tuition a. All tuition fees are non-refundable, regardless of whether the Participant completes the program or withdraws from it at any time.

Sign here to confirm your interest as an applicant. Your application will be reviewed by our committee and you will be informed of next steps as needed.

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JOWMA Medical Rotation at Schneider Children's Medical Center

To apply for this rotation, please provide two professional references.